NPIMap

Organization Active NPI

Medlink Georgia, Inc

Doing business as MedLink Commerce

  • Federally Qualified Health Center (FQHC)
  • Commerce, GA
National Provider Identifier
1477068526
Registry record updated Apr 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MEDLINK GEORGIA, INC
Doing business as
MedLink Commerce
Practice address
611 Hospital Rd
Commerce, GA 30529-1143
Phone
(706) 788-2127
Fax
(706) 788-2815
NPI assigned
Dec 12, 2017
Last updated
Apr 3, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDLINK GEORGIA, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dave Ward
Title
Ceo
Phone
(706) 788-3234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

611 Hospital Rd
Commerce, GA 30529-1143

Mailing address

PO Box 459
Colbert, GA 30628-0459
Phone (706) 788-3234

Other names 1

  • MedLink Commerce Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180405001873 GA Part A Provider - Federally Qualified Health Center (FQHC) 3274442850 Practice locations: Commerce, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477068526. Details of each certification follow.

Federally qualified health center certification: CCN 111084

Legal name
MEDLINK GEORGIA INC
Doing business as
MEDLINK COMMERCE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 5, 2018
Last certification
Apr 5, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 29, 1980 in GA
Enrollment address
611 Hospital Rd
Commerce, GA 30529-1143

National Provider Directory

National Provider Directory
Tax ID family
NE Ga Family Med Ctr in47 organizations share this tax ID, including this one
Part of
NE Ga Family Med Ctr in

Other organizations with this tax ID 46

Organizations that report the same tax identification number in the National Provider Directory.

View all 46

Ownership & related parties

All disclosed owners & managing parties 21

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
David Ward Individual Corporate OfficerPresident and Ceo Jan 1, 2015
Christopher Gilley Individual Corporate OfficerCfo Jul 21, 2021
Linda Rame Individual Corporate DirectorVolunteer Community Board of Direct Sep 20, 2022
Dennis Kimbrell Individual W-2 Managing EmployeeDirector of Pharmacy SVC Aug 5, 2017
Bobby Berryman Individual Corporate Director Feb 22, 1999
Arthur Gorman Individual W-2 Managing EmployeeDirector of Imaging Jan 3, 2022
Marilyn Favors Individual Corporate Director Mar 19, 2009
Medlink Georgia Inc Organization, Colbert, GA Non-profit Operational/Managerial Control Feb 8, 2018 100%
Merlin Mejia Individual Corporate DirectorVolunteer Community Board of Direct Sep 17, 2019
Tyler Wallace Individual Corporate DirectorVolunteer Community Board of Direct Feb 20, 2024
Angelia R West Individual W-2 Managing EmployeeDirector of Revenue Cycle MGMT Apr 1, 2013
Alexandra Duvall Individual Corporate DirectorVolunteer Community Board of Direct Sep 21, 2021
Joe Fernandez Individual Corporate Director Jun 17, 2012
Douglas Bridges Individual Corporate Director Jan 21, 1993
Gary Morris Individual Corporate DirectorVolunteer Community Board of Direct Oct 14, 2018
Nancy Lord Individual Corporate Director Jan 21, 2017
Mushtaq Ahmed Individual Corporate OfficerChief Medical Officer Sep 1, 2016
Trisha Jones Individual W-2 Managing EmployeeDirector of Nursing May 7, 2024
Cassandra Saffold Individual Corporate Director Apr 18, 2017
John Barber Individual Corporate DirectorVolunteer Community Board of Direct Jul 19, 2022
Sherrie Stone Individual W-2 Managing EmployeeDirector of Operations Mar 15, 2015

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Medlink HabershamDemorest, GA, CCN 111975 Federally qualified health center Operational/Managerial Control Jan 13, 2014
Medlink MonroeMonroe, GA, CCN 111037 Federally qualified health center Operational/Managerial Control (100%) Jun 5, 2023
Medlink DanielsvilleDanielsville, GA, CCN 111049 Federally qualified health center Operational/Managerial Control (100%) Jan 14, 2022
Medlink Winder Womens CenterWinder, GA, CCN 111050 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2016
Medlink JeffersonJefferson, GA, CCN 111141 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2021
Medlink SuchesSuches, GA, CCN 851107 Federally qualified health center Operational/Managerial Control (100%) Oct 20, 2021
Medlink ClevelandCleveland, GA, CCN 851100 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2021
Medlink Georgia IncCleveland, GA, CCN 111898 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2022
Medlink OconeeWatkinsville, GA, CCN 851834 Federally qualified health center Operational/Managerial Control (100%) Apr 22, 2023
Medlink AthensAthens, GA, CCN 851950 Federally qualified health center Operational/Managerial Control (100%) Aug 3, 2023

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680480000000",
    "number": "1477068526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 459",
            "city": "COLBERT",
            "state": "GA",
            "postal_code": "306280459",
            "telephone_number": "706-788-3234",
            "fax_number": "706-788-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 HOSPITAL RD",
            "city": "COMMERCE",
            "state": "GA",
            "postal_code": "305291143",
            "telephone_number": "706-788-2127",
            "fax_number": "706-788-2815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLINK GEORGIA, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDLINK GEORGIA, INC",
        "enumeration_date": "2017-12-12",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "DAVE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-788-3234"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedLink Commerce",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Commerce, GA

Sources for this page

Verify at the official NPI Registry.